What’s New in Psychology?

What Determines the Outcome of Pediatric Brain Tumor Radiation Treatment on Cognitive Decline?   

Jim Windell

          Does the environment matter? Specifically, does the environment matter when it comes to childhood cancer patients with brain tumors?

           That was a question asked by St. Jude Children’s Research Hospital. These researchers wondered if neighborhood level support would make a difference in terms of the rates of cognitive decline after radiation therapy.

           There is a growing body of research showing that lower socioeconomic status can predict worse cognitive outcomes in pediatric brain tumor patients treated with radiation. To add to the existing research, St. Jude scientists used the economic hardship index (EHI) framework to study how a patient’s neighborhood could correlate with cognitive outcomes. The EHI is a way to account for the environment surrounding patients and it includes information on six factors: unemployment, dependency, education, income, crowded housing and poverty. That information is collected and presented at the Census block level, groups of 250 and 550 housing units, including almost every neighborhood in the United States.

           In an article published recently in Neuro-Oncology, the researchers found that a higher EHI score was associated with patients who entered treatment with lower cognitive abilities and those with a greater cognitive decline, especially in math skills, after treatment.

           According to corresponding author Heather Conklin, Ph.D., who is at the St. Jude Department of Psychology and Biobehavioral Sciences, “Economic hardship at the neighborhood level predicted how these patients performed cognitively at baseline, before radiation therapy, and then also based on what EHI quartile they were, how much they declined or stayed stable over time. The gaps that were present prior to treatment widened over time and had more of a relative impact than the well-established clinical factors, such as age at radiation therapy.”

           St. Jude patients in the study all received similar state-of-the-art care at no expense; therefore, at least some of the differences in outcomes were likely due to non-treatment factors, such as living in a high-poverty area. Within the overall EHI score components, neighborhood-level poverty was the factor that most correlated with poor outcomes.

           Essentially, this study showed that children with supportive environments fared better than children living in neighborhoods with economic hardship. Those in areas with greater economic hardship had worse baseline and long-term cognitive outcomes.

           The results, as indicated in the article, imply that policies and resources providing support at a neighborhood level may help protect high-risk pediatric brain tumor patients from cognitive decline.

           “At the simplest level, we found that a patient’s environment matters,” said Conklin. “It’s not just the diagnosis or treatment the patient receives. It’s also the family, neighborhood and support they can access that predicts cognitive outcomes.”

           Conklin went on to say that in terms of clinical practice, psychologists have to think about what they bring to the family. “Clinicians need to learn how to talk effectively to families about factors related to economic hardship,” she said. “We should be thinking creatively about how to help families we know are in a riskier category.

           “For example, we can suggest enriching activities that may fit with the caregiver’s schedule and resources to help prevent cognitive decline, like going to parks, going to libraries and reading regularly at home. We need to take into account the family’s context – these activities need to be things families can do that are free, don’t require them to take off from work and allow single parents of multiple kids to figure out how to work this into their lifestyle.”

           To read the original article, find it with this reference:

Mule, T.A., Hodges, J., Wu, S., Li, Y., Ashford, J.M., Merchant, T.E., & Conklin, H.H. (2023).  Social Determinants of Cognitive Outcomes in Survivors of Pediatric Brain Tumors Treated with Conformal Radiation Therapy. Neuro-Oncology, oad080, https://doi.org/10.1093/neuonc/noad080